Lee Nathan J, Kim Jun S, Park Paul, Riew K Daniel
Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA.
Global Spine J. 2022 Jul;12(6):1109-1118. doi: 10.1177/2192568220976092. Epub 2020 Dec 30.
STUDY DESIGN: Retrospective Cohort. OBJECTIVE: To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF. METHODS: We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level (3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. RESULTS: 546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery. CONCLUSIONS: Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations.
研究设计：回顾性队列研究。 目的：比较椎板成形术、椎板切除术/融合术和前路颈椎间盘切除融合术（ACDF）的短期疗效。 方法：我们利用一个前瞻性收集的多中心全国数据库，采用倾向评分匹配算法，比较椎板成形术、椎板切除术/融合术和多节段（3节段）ACDF（有或无椎体次全切除术）的短期疗效。对围手术期因素进行双变量分析，采用卡方检验/费舍尔精确检验和t检验/方差分析。进行多变量分析以确定短期疗效的独立危险因素。 结果：倾向评分匹配后剩余546例患者，每组182例。ACDF手术时间最长（188±79分钟），与椎板切除术/融合术（169±75分钟，p = 0.017）和椎板成形术（167±66分钟，p = 0.004）相比。ACDF住院时间最短（住院时间≥2天：ACDF为56.6%，椎板成形术为89.6%，椎板切除术/融合术为93.4%，p < 0.05）。ACDF总体并发症发生率较低（ACDF为3.9%，椎板成形术为7.7%，椎板切除术/融合术为11.5%，p < 0.05），死亡率（ACDF为0%，椎板成形术为0.55%，椎板切除术/融合术为2.2%，p < 0.05）和非计划再入院率（ACDF为4.4%，椎板成形术为4.4%，椎板切除术/融合术为9.9%，p < 0.05）。在其他结局方面，包括深静脉血栓形成/肺栓塞、急性肾衰竭、尿路感染、中风、心脏并发症或败血症，未观察到显著差异。在多变量分析中，椎板切除术/融合术（比值比17，参照：ACDF）和椎板成形术（比值比10，参照：ACDF）是住院时间≥2天的强有力独立危险因素。椎板切除术/融合术（比值比3.2，参照：ACDF）是术后30天内任何不良事件的独立预测因素。 结论：椎板切除术/融合术在术后短期内发生发病、死亡和非计划再入院的风险最高。椎板成形术和ACDF病例的短期并发症风险相似。ACDF与最长手术持续时间和最短住院时间显著相关，且个体或总体并发症、再入院或再次手术均未增加。
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